Emergency Room Charges and What to Do About Them

Washington, DCA study into medical bills, treatment costs at hospitals and emergency room charges undertaken last year and published in May by the Johns Hopkins University School of Medicine confirmed what we already know: charges for medical care can be excessive when compared to what Medicare and Medicaid interprets as the true value for services.

What we didn’t know was by how much – but we do now. The study revealed that in emergency rooms in the US, patients are billed on average as much as 340 percent more than what Medicare pays for the same service. The study also found that minorities and the uninsured bear the brunt of most of those charges.

How can they get away with that?

The Emergency Medical Treatment & Labor Act (EMTALA) passed in 1986 ensures that no one requiring treatment from a hospital emergency room will be turned away due to an inability to pay. However, there are essentially two tiers of uninsured Americans: those who can’t afford health insurance and can ill afford to pay for treatment themselves: and those who choose not to have insurance or don’t qualify for same, but nonetheless have the means to foot the bill.

The challenges for the uninsured are numerous

The uninsured with means can be a hospital’s best customer, in that charges can be inflated and patients hounded for payment without the capacity for an insurer to negotiate lower fees. Even when health insurance is involved, hospitals can inflate the cost of a service with full knowledge they’ll be hounded for a reduction by the health insurer. Fees are then reduced somewhat as both sides arrive at a compromise. But the end result is a basket of fees that is still higher than the value Medicare places on the services rendered.

The uninsured lacks that buffer, and thus feels the full weight of the billing department on their shoulders for emergency room cost. And lest one suspects that inflating a charge for treatment just because a patient carries no insurance is a fallacy, USA TODAY (07/13/17) makes that very point, suggesting in the report that “the bill they send will be higher than for an insured patient because there’s no carrier to negotiate lower prices.”

USA TODAY also references a study published in 2016 by the National Bureau of Economic Research that determined an uninsured patient reporting to a hospital for treatment faces a heightened risk for bankruptcy within four years of that hospital visit. The study suggests the risk for bankruptcy for the uninsured is doubled when compared against insured patients, or those with the means to absorb the costs with reasonable comfort.

The issue of inflated emergency room fees, over which some plaintiffs launch an ER bill lawsuit, is further complicated with the general inability of a patient – in the midst of a real emergency – to choose where he or she is taken and whether or not, for the insured the hospital or emergency room staff fall within their approved healthcare network. As more hospitals begin to outsource emergency room service, it’s almost impossible to know whether, or not the individual(s) treating the patient falls within their approved service network as required to qualify for reimbursement by their insurance provider.

State governments should be prepared to help

Writing in Forbes.com (09/06/17) contributor Robert Pearl, MD advocates for patients to have the right to know in advance what prices are for service: “…when a hospital intends to charge $15 for a Tylenol caplet or $100 to turn on the overhead light in an operating room.” This would be especially helpful for the uninsured that may have to foot the bill themselves – with the emergency room bill likely far, far higher than what Medicare views as the true value of service.

Conversely, when an insured patient in emergency distress is transported by ambulance to an emergency room that falls outside of their approved network for reimbursement, Pearl advocates that there is a role to play for state government to help tame unexpected costs for the patient.

To that end, the writer notes that as of September of last year 23 states had either passed, or had under consideration hospital fair-pricing laws that would help to limit the financial burden for out-of-network emergency care.

Pearl cites New York as an example of a state that has passed legislation (in 2015) helping to shield insured patients from burdensome fees. Patients, according to the legislation, “do not have to pay non-participating provider charges for emergency services…that are more than your in-network co-payment, coinsurance or deductible.”

Regardless as to whether, or not a patient receives care from an in-network or out-of-network facility – and regardless of whether, or not a patient is insured or uninsured – we come back to the Johns Hopkins study that suggests hospitals overcharge by up to 340 percent above the true value a service is worth.

No wonder people dispute a medical bill – often with an ER charges attorney in tow.